Lysis of adhesions

Why do adhesions form after a knee insult?

Adhesions in the knee may form as a result of injury or surgery, when they are triggered by inflammation and an inpouring of tissue fluids and cells as an attempt to repair the joint.

In the very early stages after injury or surgery, before motion is lost, the sticky fibrous strands can easily be broken with stretches and patellar mobilisations.

"....Once motion loss has been identified, it can be a challenging complication to manage........If motion loss is more severe or identified outside of the early postoperative period (>3 months), an arthroscopic surgical intervention should be considered"

Eric C Stiefel et al

If they become more intractable, it may be possible to break them with a manipulation under anaesthesia (MUA). If the knee continues to be inflamed and the adhesions are not broken, they may become more fibrous and turn into scar tissue that can contract and pull the soft tissue areas together too firmly to be broken with manipulations. At this stage they might yet be amenable to 'lysis of adhesions', where surgical methods are employed to break down the scar tissue.

...lysis of adhesions "...for knee arthrofibrosis significantly improves the knee ROM and functional outcomes...."

Karim M Abdelghafour et al

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Where are adhesions most likely to form in the knee?

When adhesions form, they tie down certain common areas where normally-mobile tissues are in close contact with one another in the knee.

This includes the suprapatellar pouch above the kneecap, the anterior interval below the fat pad in the region of the patellar tendon, and the capsular folds at the back of the knee.

Surgical removal of knee adhesions

There are two surgical ways to tackle adhesions - 'arthroscopic' and 'open'.

arthroscopic lysis of adhesions - The common way is via an ordinary arthroscopy which will reach most of the areas of adhesion, where the surgeon will use an instrument such as an arthroscopic shaver or a radio-frequency instrument to suck away or 'melt' the adhesions. But if there are adhesions in the musculotendinour part of the joint, then it may be necessary to do an open procedure, such as a quadricepsplasty, where a proper surgical incision has to be made rather than simply small arthroscopic portals.

"....The procedure is performed with a standard 30° arthroscope, 4.0-mm arthroscopic shaver, and arthroscopic ablator....The surgeon should use electrocautery in areas of highly vascular scar tissue and place a surgical drain to decrease the risk of postoperative hemarthrosis...."

Eric C Stiefel et al

open lysis of adhesions - If there are adhesions in the musculotendinous part of the joint, such as under the quadriceps tendon or patellar tendon, then it may be necessary to do an open procedure, such as a quadricepsplasty. In this case a proper surgical incision has to be made rather than simply small arthroscopic portals.

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Is 'lysis of adhesions' in the knee a painful procedure?

Pain after lysis of adhesions can be severe, and pain management is very significant both during and after the surgery.

The but the patient must keep complying with physiotherapy to mobilise the tissues and avoid the adhesions forming again, until the inflammatory process becomes dormant.

"....A multimodal pain control regimen should be used, including narcotics, nonsteroidal anti-inflammatory drugs, and an indwelling peripheral nerve block."

Eric C Stiefel et al

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Relationship between knee adhesions and 'cyclops lesion'

There is often a relationship between knee adhesions and the presence of a 'cyclops lesion' in the knee.

Both are relatively common after ACL reconstruction complicated by inflammation, and each may be a precursor to the other.

Relevant Expert Material

Rehabilitation after operative procedures for arthrofibrosis by Dr Frank Noyes

Forum discussions

Sway's lysis of adhesions - A patient gives her early experience of LOA.
Re: knee manipulation - A discussion of both manipulation under anaesthesia and lysis of adhesions.
Advice needed on LOA/AIR after Vail visit..... - An athlete finds his life upside down after adhesions complicate surgery.
Compilation of Arthrofibrosis Success Stories Timelines - A group of patients try to determine a timeline for recovery from knee arthrofibrosis.

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Lysis of adhesions

Why do adhesions form after a knee insult?

Adhesions in the knee may form as a result of injury or surgery, when they are triggered by inflammation and an inpouring of tissue fluids and cells as an attempt to repair the joint.

Where are adhesions most likely to form in the knee?

When adhesions form, they tie down certain common areas where normally-mobile tissues are in close contact with one another in the knee.

Surgical removal of knee adhesions

There are two surgical ways to tackle adhesions - 'arthroscopic' and 'open'.

Is 'lysis of adhesions' in the knee a painful procedure?

Pain after lysis of adhesions can be severe, and pain management is very significant both during and after the surgery.

Relationship between knee adhesions and 'cyclops lesion'

There is often a relationship between knee adhesions and the presence of a 'cyclops lesion' in the knee.

Relevant Expert Material

Other relevant links

Forum discussions